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Summers in Iowa with Emily Sinnwell

Emily Sinnwell DNP, ARNP, FNP-BC
It’s so rewarding to go out and serve these people, and they are so appreciative. I feel honored to be able to hear them talk about their lives.
Summers in Iowa with Emily Sinnwell

During the busy summer months, Emily Sinnwell, DNP, ARNP, FNP-BC, operates migrant farmworker clinics at farms throughout Iowa for Proteus Migrant Health Program. Local seasonal workers, migrant workers travelling singly from Texas and Guatemala, and hundreds of workers brought up by bus from Mexico by farmers arrive at Iowa farms to assist in corn de-tasseling, the process of removing the tassels of corn to prevent cross-pollination. Toward the end of the de-tasseling season, Sinnwell says her goodbyes. “I say, ‘I’ll see you in one year, and they [often] respond, ‘si Dios quiere’ – if God wants,” she recalled.  Many of the patients do return, year after year, says Sinnwell, like one patient she first saw last year, at an on-site clinic, set up in a barn with a dirt floor.

“His blood sugar was off the meter,” Sinnwell said. “He had no idea that he is diabetic,” she continued. “One of the real reasons that I like this work is because we get to prevent ER visits, because if this [continued] undetected, he [would] eventually end up in the ER, or die.… I was able to get him on insulin right there on-site, and it was a situation where he didn’t need to go to the ER,” said Sinnwell. She prescribed him medication and consulted with him on diet and health. During a second site visit, the patient asked more questions about diet.  This year, he returned to Iowa and came to an on-site clinic in September. In one year, he managed to get his diabetes fully under control, and Sinnwell was able to take him off of all medications related to his diabetes. “He’s taking it seriously and we’ll just keep monitoring it,” whenever she is able to see him again, which might not be until next summer. Despite the inconsistent care, the on-site visits proved enough to successfully tackle his chronic disease.

URGENT CARE FOR CHRONIC CONDITIONS

The urgency of patients’ illnesses is not uncommon, says Sinnwell. “Sometimes we call our clinics ‘urgent care for chronic conditions,’ because we see a lot of chronic conditions among our migrant farmworkers, like diabetes, hypertension, and hyperlipidemia, and we only get to see them one time every year, and sometimes they’re not getting any care besides that,” she explained. “That’s one of the huge barriers for me as a provider, to be able to give them the best care—and all the care they need—in one visit.”

She credits her fluency in Spanish with helping her connect with patients, who are largely Latino. “I feel that [patients] can really talk to me and tell me what’s going on, because I speak their language,” she believes. “I feel like they ask extra questions [that] they might not [ask] with an interpreter.… We have an immediate connection because of the language.” She learns about their homelands, their lives, and the family members they have left behind.

LIVING ABROAD

Sinnwell was born and raised in Iowa, where, at a young age, she assisted refugee families in assimilating into the US, and volunteered with Des Moines Catholic Worker. As a teen, she spent time volunteering at an orphanage in Guatemala. After receiving her Registered Nurse degree in 2006, she moved to Chiapas, a state in southern Mexico, where she worked in a government hospital in the operating room and recovery. One or two days a week, she volunteered in local community health efforts. 

“My time in Chiapas really made me a good fit” for the job at Proteus, she said. “I have lived and worked in [the Mexican] culture, specifically in health care, learned their language, and got to know their family traditions, things that are important to them, and their beliefs.”  The majority of the Latino population with which she works are from Texas, Mexico, and Guatemala, she said.

ADVANCED DEGREE STUDIES AND ENCOUNTERS WITH MCN

While in Mexico, Sinnwell started her Nurse Practitioner’s degree through an online program with the University of Iowa. After graduation, she began to work for Proteus, and she chose to focus her doctorate degree project on the use of MCN’s Health Network (HN) at Proteus, with a project entitled “Improving Continuity of Care among Migrant Farmworkers with Chronic Conditions.”  She began training Proteus clinicians on HN, the bridge case management system that helps provide continuity of care for mobile patients by connecting patients to health clinics as they move, and by providing resources and support for clinicians working with those mobile patients.  Clinicians were trained on how the program worked and how to enroll patients in the network. She evaluated the training and subsequent patient enrollments at the end of the corn season.

As a result of her project, a higher number of patients were enrolled in HN, leading to greater continuity of care for those patients, she said. “We continue to orient our staff about this resource and keep following up on patients’ cases. It’s been really great for a lot of patients,” said Sinnwell. In 2014 she repeated the orientation for Proteus providers, and the number of enrolled patients stayed steady.

“I am wanting to focus more in this off-season … [on] follow-up in some of these cases.  So we are enrolling all these patients, but is it really making a difference?” she asked. As a smaller health center, she says, she is able to track her patients individually and assure that care continued after enrollment in HN.  (Last year, she says, Proteus’s clinics for farmworkers saw about 1,500 patients, with roughly 2,500 encounters.)  Currently, HN provides updates to clinics when a patient has completed care and a case is considered closed. Sinnwell hopes to take the case management a step further by monitoring open cases throughout the year.

FRUSTRATIONS AND APPRECIATIONS

Despite this strong dedication to continuity of care, Sinnwell struggles to meet the health care needs of the seasonal and migrant farmworkers in her community.

“Although we’ve had a lot of good changes in being able to purchase health insurance, there’s still a huge gap in people who can’t,” she said. She hopes to see changes that would make health insurance “available for everybody, so that we can all get seen, and not only when [we are] sick, but when [we’re] healthy.”

Yet Sinnwell remains optimistic, and continues to work to better serve her patients; she is currently pursuing her mental health certification, which she hopes to integrate into her work at future clinics. Even through the struggles, Sinnwell sees the need for her work and the appreciation from her patients, saying: “It’s so rewarding to go out and serve these people, and they are so appreciative. ... I feel honored to be able to hear them talk about their lives.”

30 CLINICIANS MAKING A DIFFERENCE is a project celebrating Migrant Clinicians Network's 30th anniversary through the life stories of 30 clinicians making a difference in migrant health. Learn more about Migrant Clinicians Network.

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